| NPI | 1659325587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: TN 44655) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 211205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 44655) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-06-18 |